The Role of Metabotropic Glutamate Receptor 1 Dependent Signaling in Glioma Viability.

Glioma refers to malignant central nervous system tumors that have histologic characteristics in common with glial cells. The most prevalent type, glioblastoma multiforme, is associated with a poor prognosis and few treatment options. On the basis of reports of aberrant expression of mGluR1 mRNA in glioma, evidence that melanoma growth is directly influenced by glutamate metabotropic receptor 1 (mGluR1), and characterization of ß-arrestin-dependent prosurvival signaling by this receptor, this study investigated the hypothesis that glioma cell lines aberrantly express mGluR1 and depend on mGluR1-mediated signaling to maintain viability and proliferation. Three glioma cell lines (Hs683, A172, and U87) were tested to confirm mGluR1 mRNA expression and the dependence of glioma cell viability on glutamate. Pharmacologic and genetic evidence is presented that suggests mGluR1 signaling specifically supports glioma proliferation and viability. For example, selective noncompetitive antagonists of mGluR1, CPCCOEt and JNJ16259685, decreased the viability of these cells in a dose-dependent manner, and glutamate metabotropic receptor 1 gene silencing significantly reduced glioma cell proliferation. Also, results of an anchorage-independent growth assay suggested that noncompetitive antagonism of mGluR1 may decrease the tumorigenic potential of Hs683 glioma cells. Finally, data are provided that support the hypothesis that a ß-arrestin-dependent signaling cascade may be involved in glutamate-stimulated viability in glioma cells and that ligand bias may exist at mGluR1 expressed in these cells. Taken together, the results strongly suggest that mGluR1 may act as a proto-oncogene in glioma and be a viable drug target in glioma treatment.

Racial And Ethnic Discrimination During Clinical Education and Its Impact on the Well-Being of Nurse Anesthesia Students.

The effects of racial/ethnic discrimination in the clinical setting have been shown to cause psychological distress in populations of healthcare workers. However, there are currently no published studies that investigate racial/ethnic transgressions in the clinical arena and their impact on the well-being of student registered nurse anesthetists (SRNAs). The current study aimed to investigate 1) the prevalence and nature of racial/ethnic bias during clinical education and 2) its impact on wellness in a cohort of SRNAs. Data were collected using a three-part 16-item electronic questionnaire distributed to a national sample of SRNAs. A significant association was found between race/ethnicity and an increased incidence of discrimination (χ2 [5] = 24.1, P < .001). SRNAs who described experiencing at least one discrimination encounter during their training had significantly higher mean Well-Being Index scores-associated with more distress-compared with those students who had never experienced discrimination (P < .05). Participant responses were categorized into five major themes: overt discrimination, covert discrimination, disparate treatment, barriers to reporting, and incivility/bullying. Addressing the distinctive challenges related to race/ethnicity in clinical sites is paramount to ensuring the success of minority SRNAs.

Temporary Intraoperative Handoff Report Among Nurse Anesthetists: Utilization of Standardized Handoff Tools and Barriers to Implementation.

The demanding nature of the intraoperative period presents several distractions to anesthesia providers that can hinder effective communication. Implementation of intraoperative and postoperative standardized handoff protocols have improved provider communication; however, these protocols remain underutilized. While temporary anesthesia handoffs arise more frequently than permanent handoffs, limited data exist on how the specific transfer of care processes transpire. The purpose of this study was to explore the usage of standardized handoff tools among certified registered nurse anesthetists, as well as the barriers to implementation during temporary intraoperative handoff. Data from this exploratory mixed-methods study were collected using a 16-question voluntary electronic survey. Most participants (81.2%) reported that they do not use a standardized handoff tool during temporary handoff, but over half (57.1%) believed such tools should be used. Study participants who used a standardized handoff tool were significantly less likely to rank "increases the time spent giving a handoff" as an important barrier (48.6%) compared with those who did not use a tool (71.9%), ( X2(1) = 7.39, P = .007, V = .19). Failure to make standardized handoffs a facility standard of care and lack of reception by receiving anesthesia providers were also ranked as major barriers to implementation.

Assessing CRNA Knowledge of Local Anesthetic Systemic Toxicity Treatment.

Local anesthetic systemic toxicity (LAST) is a rare life-threatening adverse event. Due to the potential for devastating patient outcomes, it is crucial for anesthesia providers to understand appropriate LAST management. The primary aim of this study was to assess certified registered nurse anesthetist (CRNA) knowledge of the 2020 American Society of Regional Anesthesia and Pain Medicine (ASRA) LAST treatment guidelines. The secondary aim was to determine whether there was a relationship between the frequency of CRNAs' exposure to perioperative local anesthetic use and their knowledge level. A quantitative descriptive study and national American Association of Nurse Anesthetists electronic survey solicited practicing CRNAs. Survey findings revealed knowledge scores averaging 47.3% among 184 respondents. Almost all (97.8%) recognized the importance of early lipid emulsion administration. Over half (54.3%) were unaware of the recommended epinephrine dosing during LAST. No relationship was found between knowledge level and CRNAs' exposure to local anesthetics. Those who reported having immediate access to written or electronic guidelines in the event of LAST had significantly higher knowledge scores than those without access (P = .049). Implementing cognitive aids may help bridge knowledge gaps identified in this study and ensure critical steps are not missed. Further studies examining the use of cognitive aids to improve CRNA knowledge of LAST management may be beneficial in the future.

Examination of a Nurse Anesthesia Program's Teaching Assistant Model and Its Impact on Increasing Nurse Anesthesia Education Capacity.

A nurse anesthesia educator shortage exists that is attributed to factors such as a lack of financial incentive and proper training to be an educator. Due to the faculty shortage, nurse anesthesia programs (NAPs) are forced to defer admission to qualified applicants which reduces the number of certified registered nurse anesthetists (CRNAs) that NAPs can produce. Research regarding students as teaching assistants (TAs) at the university level has shown benefits and challenges to students, professors, and the TAs themselves as well as the impact on the overall faculty capacity. Current research regarding TA programs does not pertain to NAPs, therefore, research regarding the impact of TA programs on increasing nurse anesthesia faculty merits further work. This study was conducted using quantitative surveys and qualitative interviews to bridge the gap in the literature on the potential impact of TA programs on NAP faculty shortages. A survey was sent via email to former TAs (n = 44) of the Georgetown University NAP to assess the impact that the TA program had on their decision to enter a role in academia after graduation. Interviews were then conducted on a voluntary basis via a video conferencing platform to add qualitative data to the survey results. The survey response rate was 45% (n = 20). Following proportional analysis, 80% of the survey respondents indicated that they participated in the education of student registered nurse anesthetists in the clinical or didactic setting as a CRNA. Eighty percent of respondents indicated that being a TA positively influenced their desire to become a faculty member. One hundred percent of CRNAs interviewed reported that the biggest barrier to becoming fulltime faculty was the lack of financial incentives offered by NAPs. Interviewees recalled their TA experience as the foundation for their enjoyment of teaching anesthesia. The results of this study indicate that TA programs in NAPs can be used as a method to increase faculty capacity.

Identifier Bouffants: An Exploration of the Impact on Verbal Communication Among Interdisciplinary Operating Room Personnel.

Effective team communication reduces errors in the perioperative environment and is an essential component of patient safety. Although name and title recognition are beneficial in enhancing communication, often members of the interdisciplinary team are unfamiliar with their colleagues. This lack of familiarity is worsened when the visual cue of a name badge is obscured under sterile scrub attire. The primary purpose of this quasi-experimental study was to explore whether or not the use of identifier bouffants, which provided a visual cue of the anesthesia provider's name and position on their forehead, impacted verbal communication and familiarity within the operating room team. Participation in this study was voluntary and data were collected using a twenty-five question Likert-Scale survey. A significant association was identified between the presence of an identifier bouffant in the operating room and self-reported increased communication amongst the interdisciplinary operating room team (z = 5.42, P <.001). Of the 72 participants meeting inclusion criteria, 59 (82%) agreed that verbal communication was enhanced by the use of identifier bouffants in the operating room. Further exploration of strategies to improve name and title recognition in the operating room setting are supported by the results of this study.

The Experience of Burnout in the SRNA Population and Association With Situational and Demographic Factors.

There is limited research regarding student registered nurse anesthetist (SRNA) burnout. To our knowledge there is no recently published work that has explored the associations between characteristics of SRNAs and burnout. Addressing this gap could establish the SRNA experience of burnout, identify demographic characteristics and situational factors that may correlate with burnout, and lay the foundation for future research. The purpose of this exploratory descriptive study was to assess the SRNA experience of burnout and any relationship between burnout to demographic or situational factors via the Oldenburg Burnout Inventory-S and demographic questions.The research questions were: 1) Do SRNAs experience different levels of burnout during the didactic curricula and/or clinical training element of nurse anesthesia school? 2) Is there an association between SRNA burnout and demographic or situational factors? Power analysis set the minimum n at 421. Five hundred thirty SRNAs responded to the randomized survey through the American Association of Nurse Anesthesiology. Data analysis was conducted using one-way ANOVA, Spearman's rho, 2-tailed t-test, and Chi square analysis. More hours in class per week correlated with lower exhaustion scores. Higher disengagement scores were reported by SRNAs further in their training, while more hours per week in clinical correlated with both higher disengagement scores and increased total burnout scores.

Estimation of Surgical Blood Loss by Anesthesia and Surgical Trainees: Impact of an Educational Intervention on Interrater Reliability.

Intraoperative blood loss estimation by members of the anesthesia and surgical teams is often inaccurate, with potentially detrimental clinical consequences. Despite this, few trainees receive standardized training in blood loss estimation. This study examined the impact of an educational intervention for visual blood loss estimation on anesthesia and surgical trainees' accuracy and interrater reliability. A quasi-experimental study was conducted with student registered nurse anesthetists (SRNAs) and orthopedic surgery residents. The groups' mean visual blood loss estimations at 7 simulated stations were compared before and after an educational intervention. Low, moderate, and high blood loss volumes were simulated with common operating room materials and theater blood. Of the 42 participants, 29 (70%) reported no previous formal training in blood loss estimation. Before the educational intervention, orthopedic surgery residents underestimated blood loss values at all stations, whereas the SRNAs tended toward overestimation. Following the educational intervention, there was no significant difference between the groups' mean estimations. Both groups had a significant reduction in estimation error and improved interrater reliability (P<.001). The results of this study demonstrate that a multimodal educational intervention can improve visual blood loss estimations by surgical and anesthesia trainees, supporting implementation of such programs during anesthesia and surgical training.

Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.

Marijuana consumption is growing in the United States because of state legalization for recreational and medical use. However, many anesthesia practitioners are unaware of the potential adverse effects that may occur if marijuana is taken before the administration of an anesthetic. This review provides a history of marijuana use, the current laws and regulations, the pharmacology of marijuana, and best evidence-based practices related to anesthetic care of the marijuana user.

Atypical signaling of metabotropic glutamate receptor 1 in human melanoma cells.

The metabotropic glutamate 1 (mGlu1) receptor has emerged as a novel target for the treatment of metastatic melanoma and various other cancers. Our laboratory has demonstrated that a selective, non-competitive mGlu1 receptor antagonist slows human melanoma growth in vitro and in vivo. In this study, we sought to determine if the activation of a canonical G protein-dependent signal transduction cascade, which is often used as an output of mGlu1 receptor activity in neuronal cells, correlated with mGlu1 receptor-mediated melanoma cell viability. Glutamate, the endogenous ligand of mGlu1 receptors, significantly increased melanoma cell viability, but did not stimulate phosphoinositide (PI) hydrolysis in several human melanoma cell lines. In contrast, melanoma cell viability was not increased by quisqualate, a highly potent mGlu1 receptor agonist, or DHPG, a selective group I mGlu receptor agonist. Similarly to glutamate, quisqualate also failed to stimulate PI hydrolysis in mGlu1 receptor-expressing melanoma cells. These results suggest that the canonical G protein-dependent signal transduction cascade is not coupled to mGlu1 receptors in all human melanoma cells. On the other hand, dynamin inhibition selectively decreased viability of mGlu1 receptor-expressing melanoma cells, suggesting that a mechanism requiring internalization may control melanoma cell viability. Taken together, these data demonstrate that the approaches commonly used to study mGlu1 receptor function and signaling in other systems may be inappropriate for studying mGlu1 receptor-mediated melanoma cell viability.

Providing safe passage: rapid sequence intubation for advanced practice nursing.

Rapid sequence intubation (RSI) is a lifesaving technique performed by advanced practice nurses when patients require endotracheal intubation but are at risk for gastric aspiration. In the acute care setting, the procedure often is indicated when critically ill or injured patients exhibit difficulty maintaining a patent airway and/or are displaying inadequate oxygenation and ventilation. The goal of this article is to provide advanced practice nurses with information that promotes safe and effective clinical decision making during RSI on the basis of the current state of the science. Standard RSI practices in stable patients are reviewed, and the need for individualized modifications of this "ideal" practice in unstable, critically ill patients is addressed. Factors predisposing a patient to difficult airway management, proper equipment, and patient preparation are highlighted, along with the relevant pharmacology. Finally, prevention of potential complications during RSI in the acute care setting is discussed.